Kim Byung Kook, Kwon So Young, Lee Chang Hong, Choe Won Hyeok, Choi Hong Mi, Koo Hye Won
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Korean J Hepatol. 2009 Mar;15(1):25-41. doi: 10.3350/kjhep.2009.15.1.25.
BACKGROUND/AIMS: The purpose of this study was to evaluate the cost-effectiveness of 1 year and up to 5 years of antiviral treatment for chronic hepatitis B (CHB).
Two ten-health-state Markov models were developed for CHB patients. The proportion of patients remaining alive in each health state, and healthcare costs and quality-adjusted life years (QALYs) were determined during annual cycles of these Markov models. The total healthcare costs, life years, and QALYs over the 40-year time horizon of the model were calculated. The perspectives of the cost-effectiveness analysis were the Korean healthcare system and the healthcare needs of the CHB patient.
Short-course therapy with alpha-interferon or 1-year treatment with pegylated interferon alpha-2a, lamivudine (LMV), or adefovir (ADV) had limited impact on disease progression. In contrast, either LMV-ADV or ADV-LMV as rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. The cost-effectiveness threshold in Korea was estimated to be approximately 25,000,000 South Korean won. LMV administered for 1 year is cost-effective in comparison with no treatment for both HBeAg-positive and HBeAg-negative CHB patients, but longer duration antiviral therapies administered for up to 5 years in CHB patients were found to be highly cost-effective by international standards.
Antiviral treatment of CHB with LMV or ADV for up to 5 years using the alternative antiviral agent as rescue medication appears to be a cost-effective strategy for both HBeAg-positive and HBeAg-negative CHB patients in Korea. Economic evaluation of antiviral therapies should be studied further and updated, particularly for newer agents.
背景/目的：本研究旨在评估慢性乙型肝炎（CHB）患者接受1年及长达5年抗病毒治疗的成本效益。
为CHB患者建立了两个包含十个健康状态的马尔可夫模型。在这些马尔可夫模型的年度周期中，确定每个健康状态下存活患者的比例、医疗成本和质量调整生命年（QALY）。计算模型40年时间范围内的总医疗成本、生命年和QALY。成本效益分析的视角是韩国医疗体系和CHB患者的医疗需求。
使用α干扰素进行短程治疗或聚乙二醇化干扰素α-2a、拉米夫定（LMV）或阿德福韦（ADV）进行1年治疗对疾病进展的影响有限。相比之下，将LMV-ADV或ADV-LMV作为挽救药物使用5年可使疾病进展率更持续地下降。韩国的成本效益阈值估计约为25000000韩元。对于HBeAg阳性和HBeAg阴性的CHB患者，与不治疗相比，使用LMV进行1年治疗具有成本效益，但按照国际标准，对CHB患者进行长达5年的更长疗程抗病毒治疗被发现具有很高的成本效益。
在韩国，对于HBeAg阳性和HBeAg阴性的CHB患者，使用替代抗病毒药物作为挽救药物，用LMV或ADV进行长达5年的CHB抗病毒治疗似乎是一种具有成本效益的策略。应进一步研究并更新抗病毒治疗的经济评估，尤其是针对新型药物。
